1467492132 NPI number — M SHANNON ARNSBERGER DO

Table of content: M SHANNON ARNSBERGER DO (NPI 1467492132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467492132 NPI number — M SHANNON ARNSBERGER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNSBERGER
Provider First Name:
M
Provider Middle Name:
SHANNON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467492132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ELDORADO BLVD STE 6250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80021-3421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-272-0768
Provider Business Mailing Address Fax Number:
303-318-2488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 CAMPUS DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80026-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-673-1900
Provider Business Practice Location Address Fax Number:
303-673-1915
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  42063 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07573740 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00148071 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com